Present techniques for laparoscopic surgery involve the establishment of pneumoperitoneum through carbon dioxide gas insufflation, which is necessary to provide a working cavity by displacing the peritoneum and anterior abdominal wall. As is understood, these techniques--utilizing a Trocar to puncture the abdominal wall, and a cannula to insufflate the carbon dioxide gas--offer several advantages over open surgery--for example, access to the abdominal cavity is achieved by only a small puncture incision yielding only small wounds, and a much shortened recovery period, measured in "days", rather than in "weeks". However, certain disadvantages have been noted.
For example: 1) maintenance of the exposure requires that there be airtight entry ports and a high flow insufflation--at inopportune moments, on the other hand, a loss of pneumoperitoneum may occur if there are leaks in the Trocar ports or during the insertion and/or use of the laparoscopic instrument; 2) the high pressure carbon dioxide insufflation oftentimes causes shoulder pain due to phrenic nerve irritation and may further threaten patients with pre-existing cardiopulmonary disease with gas embolism; 3) acid-based disturbances have also been noted with high flow carbon dioxide insufflation, which has been observed to lead to excessive patient cooling during lengthy procedures. Other studies, furthermore, suggest that these types of high-pressure procedures may not be desirable with obese patients, pregnant women, or for those suffering with chronic Bronchitis.